Published: 07/10/2004, Volume II4, No. 5926 Page 8 9

The chair of the National Institute for Clinical Excellence has urged patients' groups to take the NHS to court if it fails to provide the drugs and treatments it recommends.

Professor Sir Michael Rawlins said he would 'love' to see such action taken in order to push the message that the recommendations of NICE technology appraisals are mandatory. He was addressing a fringe meeting of the Labour Party conference last week He told delegates: 'What I would love to see is a group of patients' organisations taking one trust to judicial review. It doesn't even have to get to court - but it would send the message out.'

The NHS has been legally obliged to provide funding for medicines and treatments recommended by NICE since January 2002. Sir Michael made his remarks after several delegates at the fringe session said 'postcode prescribing' continued in many parts of the country.

He said he had no doubt what would happen if an organisation failing to follow the guidance was taken to court: 'Where they do not do so they are in breach of the law and they would lose badly in judicial review.'

Sir Michael acknowledged that ensuring the implementation of guidelines was key to the success of NICE. He said there were several ways this could be tackled.

Choosing the right topics for examination in the first place might improve the take-up of the resulting guidance, he suggested.

Earlier he had explained: 'I am not entirely happy with the topics selection. I am not sure whether they are what the health service wants or whether they are what people think the health service wants.'He also said NICE was trying to improve implementation by providing health economies with planning templates.

NICE is currently in 'deep dialogue' with the Healthcare Commission about how the commission will fulfil its brief to monitor implementation of guidance, he said.

Asked how he would like to see the commission carry out this role, Sir Michael said: '[It] might go to trusts and ask to see a sample of audits.' Later he told HSJ the commission had been 'very receptive' to the suggestion, which could fit in with its proposals for a system based on 'intelligent information' rather than visits. 'This could be done by e-mail, ' he added.

Addressing delegates, he outlined a number of other levers which could be used to improve uptake of guidance, including persuading the government's independent advisory committee on clinical excellence awards to support NICE: 'I had a slightly naughty thought. Hospital consultants get clinical excellence awards. It could be that one of the components would be demonstrating that they had introduced NICE guidance... There is nothing like money to focus the mind.'

Sir Michael gave a frank outline of some of the other challenges facing his organisation. He described the timelines between the production of a drug or treatment and a NICE judgement as 'embarrassingly long' - a problem which he blamed on the lack of capacity at NICE and a limit to what the NHS can absorb.

But he said NICE was improving in this area, and was now 'starting technology appraisals long before [drugs and treatments] go on the market'.

Sir Michael said NICE's work on cost-effectiveness required further development. And he said NICE should examine the risks of drugs to patients with risks of comorbidity, given that 'over 70 per cent of patients with one chronic disease have another.'

And he restated previous calls for NICE to expand its remit to include screening and immunisation.